American Board of Pediatrics: General Pediatrics; Pediatric Endocrinology

Research

Preserving health and development of youth with diabetes

Lori Laffel, M.D., M.P.H., focuses her research and clinical interests on preventing the late complications of type 1 diabetes and preserving the health, normal growth, development and family functioning of children, adolescents and young adults with diabetes. Under her leadership, the Joslin Clinic Pediatric, Adolescent and Young Adult Section has nearly quadrupled in size, with a large pediatric research program complementing the clinical activities. Dr Laffel and her associates have ongoing studies looking at factors that are predictors of persistence and progression of micralbuminuria in childhood type 1 diabetes onset.

A primary focus of Dr. Laffel's research has been the design, implementation, and evaluation of office-based interventions aimed at increasing family involvement in the day-to-day care of youth with diabetes in order to prevent the expected deteriorations in self-care behaviors and glycemic control that usually occur in late adolescence. This effort has had ongoing funding from the National Institutes of Health and private foundations since 1993. Currently, her research interests include the study of the relationship between nutrition and type 1 diabetes, with 5 years of funding from the National Institute of Child Health and Human Development (NICHD). She also serves as Principal Investigator on an investigation examining barriers to sustained Continuous Glucose Monitoring use in youth and a behavioral intervention to facilitate adherence to diabetes management tasks in teens. Both of these investigations are funded by NIH.

Together with collaborator Barbara Anderson, PhD, now at Baylor College of Medicine, Dr. Laffel pioneered the development and implementation of a cost-effective model of care in which a “Care Ambassador” encourages routine clinic attendance and adherence to diabetes management tasks, such as blood glucose monitoring. Her studies have documented a 30-50% reduction in the rate of acute complications, namely severe hypoglycemia, hospitalizations, and emergency room visits, among patients who received the “Care Ambassador” intervention compared with standard care. These successful research efforts have been translated into the routine clinical care for families of children with newly diagnosed diabetes at Joslin and help to form the basis of national and international initiatives. The “Care Ambassador” intervention approach to care also served as the basis for a multi-center clinical trial of the family management of type 1 diabetes in youth funded by the National Institute of Child, Health and Human Development.

Working with colleagues in the section on Genetics and Epidemiology, the section on Complications, and at Brigham and Women's Hospital, Dr. Laffel identified predictors of early kidney disease in young patients. In association with colleagues in Joslin's Section on Genetics and Epidemiology, she found that risk for diabetic nephropathy increases in patients with infrequent medical follow-up and in those whose hemoglobin A1c values exceed a threshold value of 8 percent. These and other findings laid the foundation for prevention and treatment interventions. For example, Dr. Laffel was the lead author of a study that established the use of angiotensin-converting enzyme (ACE) inhibitors as the standard of care to preserve kidney function in certain patients with type 1 diabetes.

In an effort to evaluate new technologies, Dr. Laffel secured funding from the Juvenile Diabetes Research Foundation (JDRF) to evaluate continuous glucose monitoring (CGM) in youth with type 1 diabetes and served as the co-chair of the multi-center JDRF CGM study. She has also worked with students and fellows from the MIT and Harvard informatics training programs to design, implement, and evaluate wireless technologies aimed at increasing adherence in youth and young adults with type 1 diabetes.

With the current epidemic of childhood obesity and type 2 diabetes in youth, Dr. Laffel has expanded her research interests to include the study of effective approaches for the treatment of type 2 diabetes in youth. She serves as Principal Investigator at the Joslin site in a national multi-center clinical trial of type 2 diabetes in youth funded by the National Institute of Diabetes and Digestive and Kidney Diseases.